CMS Pub. 100-11, ch. 13, § 20

PACE organizations are paid monthly prospective payments for each eligible enrolled

PACE program participant in accordance with Sections 1853 and 1894(d)(1) of the Act.

For Medicare Part A-only participants who are also eligible for Medicaid, the State is

obligated to pay some Medicare Part B premiums under Section 1902(a)(10) of the ACT.

The PACE organization is required to do the following:

• Verify at time of enrollment whether the participant is dually eligible for

Medicare and Medicaid and whether the participant has Medicare Part A

and/or Part B;

• Remind participants that unless they are dually eligible, they will need to

continue to pay their Medicare Part A premium, if not free, Part B (if not

eligible for State coverage) and/or Part D premiums, if applicable;

• Submit risk adjustment/encounter data (when applicable) to CMS;

• Identify payers that are primary to Medicare;

• Determine the amounts payable by those payers;

• Coordinate benefits to Medicare participants with the benefits of primary

payers.

[42 CFR §§ 460.150, 460.152(a), 460.180; 71 FR 71309, 71318; (Dec. 8, 2006)]